PPIs to Prevent Aspirin-Induced Ulcers

Randomized trials have shown that proton-pump inhibitors (PPIs) can protect patients against gastric and duodenal ulcers caused by nonaspirin nonsteroidal anti-inflammatory drugs. Aspirin, even at low doses, also can cause gastroduodenal ulceration, but researchers have not examined PPI prophylaxis prospectively in aspirin users — until now.

In this manufacturer-sponsored international study, 992 patients (age, ≥60) who were taking daily aspirin (75–325 mg) for cardiovascular prophylaxis were randomized to receive the PPI esomeprazole (Nexium; 20 mg daily) or placebo. Patients underwent routine endoscopy at baseline, 2 months, and 6 months; those with gastroduodenal ulceration at baseline were excluded.

Compared with the placebo group, the es…